Differential Diagnosis for Abdominal Pain Upon Waking
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This condition is characterized by stomach acid frequently flowing back into the tube connecting the mouth and stomach (esophagus). Symptoms can worsen at night and cause abdominal pain upon waking due to lying down, which can exacerbate reflux.
- Other Likely Diagnoses
- Peptic ulcer disease: Ulcers in the stomach or duodenum can cause abdominal pain that may worsen at night or upon waking, especially if the ulcer is bleeding or perforated.
- Irritable bowel syndrome (IBS): Although IBS symptoms can occur at any time, some individuals may experience worsening symptoms in the morning, including abdominal pain.
- Constipation: Morning abdominal pain can be associated with constipation, especially if there is significant straining during bowel movements.
- Do Not Miss Diagnoses
- Appendicitis: Although appendicitis typically presents with pain that migrates to the lower right abdomen, it can sometimes cause generalized or upper abdominal pain, and missing this diagnosis can lead to severe consequences, including perforation and peritonitis.
- Myocardial infarction (MI): In some cases, a heart attack can present with epigastric discomfort or abdominal pain, especially in women, diabetics, or the elderly. This is a critical diagnosis not to miss due to its high mortality rate if untreated.
- Pancreatitis: Acute pancreatitis can cause severe abdominal pain that radiates to the back and worsens after eating, but it can also present with pain upon waking. Missing this diagnosis can lead to severe complications.
- Rare Diagnoses
- Intestinal obstruction: This condition involves a blockage that prevents normal flow of the products of digestion, which can cause severe abdominal pain, vomiting, and constipation. It is less common but should be considered, especially if there's a history of abdominal surgery.
- Inflammatory bowel disease (IBD) flare: Conditions like Crohn's disease or ulcerative colitis can cause abdominal pain that worsens in the morning, among other symptoms. While not the most common cause of morning abdominal pain, they are important to consider, especially in patients with a history of IBD.